Adenosine Preload vs Vial: Tips for Admin
Question# 918
Due to recent challenges with stocking the 6mg and 12mg Adenosine preloads, our pharmacy supplier has provided Adenosine 6mg/2ml (mg/ml) vials for rapid IV bolus use.
We're reaching out to seek your input on best practices for preparing and administering this formulation in a way that ensures rapid delivery while minimizing the risk of dosing errors. We aim to develop a clear memo for frontline staff outlining the proper procedure before introducing this medication to our trucks.
Your clinical expertise is appreciated, and we value your guidance in helping ensure a safe and effective rollout
We're reaching out to seek your input on best practices for preparing and administering this formulation in a way that ensures rapid delivery while minimizing the risk of dosing errors. We aim to develop a clear memo for frontline staff outlining the proper procedure before introducing this medication to our trucks.
Your clinical expertise is appreciated, and we value your guidance in helping ensure a safe and effective rollout
Answer:
Thank you for your patience and your thoughtful and safety-minded approach to introducing the Adenosine 6 mg/2 mL vial formulation into frontline practice.
Given the volumes are the same between the pre-load and vial, there is no need to adjust your day-to-day practice.
When it comes to the safe administration of adenosine, there are some minutiae that makes it unique compared to some of the other medications we carry.
It should be administered rapidly over 1-2 seconds, followed by a flush of normal saline (min. 20 mL)
Ideally, the IV site as proximal as possible to trunk (not in lower arm, hand, lower leg, or foot)
Practically, this is easier to do with the use of 2 syringes (one with adenosine dose and the other with NS flush) connected to a T-connector or stopcock, but we recognize not all service providers stock this equipment.
Either way, we encourage practice, as the medication needs to be flushed in rapidly.
Short of this factor, there is no difference in administering adenosine (pre-load or vial) than any other parenteral medication we use, and standard safe medication practices (i.e. independent double check) should apply.
Given the volumes are the same between the pre-load and vial, there is no need to adjust your day-to-day practice.
When it comes to the safe administration of adenosine, there are some minutiae that makes it unique compared to some of the other medications we carry.
It should be administered rapidly over 1-2 seconds, followed by a flush of normal saline (min. 20 mL)
Ideally, the IV site as proximal as possible to trunk (not in lower arm, hand, lower leg, or foot)
Practically, this is easier to do with the use of 2 syringes (one with adenosine dose and the other with NS flush) connected to a T-connector or stopcock, but we recognize not all service providers stock this equipment.
Either way, we encourage practice, as the medication needs to be flushed in rapidly.
Short of this factor, there is no difference in administering adenosine (pre-load or vial) than any other parenteral medication we use, and standard safe medication practices (i.e. independent double check) should apply.
References
TOH Parenteral Manual
Lexicomp
Lexicomp